Insomnia linked to post-injury headaches

UTHSC prof who was in Iraq says helping patients sleep is key.

Running a traumatic brain injury clinic at Joint Base Balad, Iraq, then-Air Force Capt. Craig Bryan knew that the most common and persistent symptom of concussion was headaches — even when the injury was minor.

And while headaches don't sound too awful, it can be deadly in combat — slowing reaction time and causing soldiers to lose focus. He began to study his injured patients and found that some unexpected factors determined whether they had a headache in the first place, and how badly it hurt.

By one estimate, one in five soldiers serving in Iraq and Afghanistan has suffered a traumatic brain injury, most of them minor. And while many are combat-related, many others are not.

“I got guys dropping weights on their heads, football injuries. Not what most people think in a combat zone,” said Bryan, a psychologist and now an assistant professor of psychiatry at the University of Texas Health Science Center. “A sizable proportion of it was tripping and falling down the stairs at night, running into each other playing basketball and stuff.”

His study, published in this month's issue of the journal Headache, found that sleep — or more correctly, a lack of it — often separated those who suffered headache after a head injury and those who didn't. Insomnia has been shown to interfere with the way the brain processes pain, the study noted.

Those who blacked out after the injury were more likely to have a bad headache. In addition, the severity of headache was linked to psychological factors — including combat stress and anxiety, as well as the degree that reactions were slowed. The slower the reaction time, the worse the headache.

“What was interesting is, we'd see a psychological variable was contributing to headache severity, whereas some other physical variables like dizziness, hearing problems, concentration problems, vision problems, did not relate to headache severity. That was kind of surprising to us.”

The best treatment proved to be helping people sleep and addressing their psychological problems as well as their physical symptoms, he said. And the very best results often came from giving head-injured patients three days off during which they stayed out of the sun and did nothing.

While commanders could be convinced that a few days away from duty could improve performance and save lives, the patients often proved to be a harder sell.

“Even if I recommended, ‘I don't want you to do any exercise; I don't want you do anything,' they'd go to the gym. They'd come back and their headaches were killing them,” Bryan said. “We really learned to be very aggressive in giving people a few days off, and they'd recover so much faster if they do that.”